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Management of Systemic Lupus Erythematosus

             •  HCQ -
                 the incidence of retinal toxicity was only 0.95/1000 patient-years
                 majority of those with retinal toxicity were on HCQ for >5 years
                 and most used doses of >6.5 mg/kg
             •  AZA -
                 incidence of leukopenia or anaemia was 5 - 20%
                 abnormal LFTs requiring discontinuation of drug in 1 - 6%
             •  MTX -
                 LFT abnormalities ranged at 10 - 50%
             •  CYC -
                 incidence of leukopenia or anaemia was 5 - 10%
                 increased incidence of cervical dysplasia in patients taking CYC
                 compared with corticosteroids alone
             •  MMF -
                 incidence of haematological toxicity was 1.1 - 36.8%
             •  NSAIDs and salicylates -
                 most  powerful  predictor  of  gastric  mucosal  injury  (OR=26.8,
                 95%CI 4.9 to 148.6)
                 reduced renal function by 58% and increased serum creatinine
                 by 163% in patients with active LN
                 abnormal liver enzymes over 10-day period of use in 44.4% of
                 patients treated with aspirin and 20% of patients treated with
                 NSAIDs
           Refer to Appendix 7 for Medication in SLE.

           9.5  Frequency and Interval

           A summary of current guidelines for laboratory monitoring as well as an
           overview of laboratory abnormalities of each drug and recommendations
           on  frequency  of  monitoring  are  provided  in  the  Appendix  7  and
           Appendix 8.

           A prospective cohort study on patients with inactive  disease  of SLE
           showed  that  a  clinic  visit  interval  of  3.8  months  was  able  to  identify
           silent manifestations of the disease .99, level II-2

           Refer to Appendix 7 for the Medication in SLE.













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